[Development and Effects of a Heart Health Diary for Self-Care Enhancement of Patients with Heart Failure]

Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study

Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.

Development of a discharge education program using the teach-back method for heart failure patients

Background

Heart failure (HF) patients have difficulties in self-management after discharge. This study aimed to develop a discharge education program for HF patients using the teach-back method (TBM).

Methods

As a methodological study to develop a program, we applied the analysis, design, development, implementation, and evaluation (ADDIE) model comprised of (1) analysis using EMR data, systematic review, and focus group interviews, (2) design and development of a program draft, (3) tests of program validity using 15 experts, 10 nurses, and 10 patients, and (4) development of the final program. The content validity index (CVI), and understandability and actionability of the educational material were used.

Results

The discharge education program provides definitions and information about medication, symptom/weight/diet management, physical activity, and other precautions. The educational method uses TBM. The overall CVI for the program was 0.96, and all item CVIs were greater than 0.8. The understandability and actionability were 90.2 and 91.3 % in patients, and 94.6 and 86.8 % in nurses. The contents and methods of the program were appropriate for patients and providers.

Conclusions

We expect the discharge education program using TBM to enhance self-management among HF patients. The process we used to develop this program could guide researchers and clinical practice.

Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records

We examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.

Development of a Mobile App-Based Self-care Health Diary for Heart Transplant Recipients: A Pilot Study

Self-care is an essential concept in health maintenance for patients with heart problems. Mobile applications have received significant attention for their efficacy in facilitating lifestyle management. This study aimed to develop a practical mobile application for Android smartphones to aid in the self-care of heart transplant recipients. Development followed the five stages of the ADDIE model (analysis, design, development, implementation, and evaluation). The developed self-care health diary application provides users with a detailed guide to information and behaviors necessary for self-care through two main components: "Health information" and "Health diary." We conducted a 5-day pilot test with six subject experts and four heart transplant recipients. The participants were unanimously satisfied with the application's content, but experienced difficulty with its functionality, such as screen display and button operation. The feedback was used to revise and update the application, leading to the development of the final version. This study and application significantly contribute to the creation of a sustainable healthcare environment for the growing number of heart transplant recipients by enabling them to perform daily self-care. In future, education and promotion are required for encouraging heart transplant recipients to use the application regularly and proactively.

Effects of a smartphone-based self-care health diary for heart transplant recipients: A mixed methods study

AIM

This study evaluated the effectiveness of a smartphone-based self-care health diary based on the Information-Motivation-Behavioral Skills model, designed to enable transplant recipients to self-manage their health and increase their adherence to medical advice.

BACKGROUND

Heart transplant recipients must take immunosuppressants to prevent rejection for the rest of their lives. As immunosuppressant drugs suppress the immune system, transplant recipients are like individuals battling chronic diseases and must be diligent about self-care to keep healthy.

METHODS

This was a quasi-experimental study using a nonequivalent control group pretest-posttest non-synchronized design and mixed methods. The sample comprised of 56 patients, with 28 each in the experimental and control groups. The control group was recruited from May 25-June 19, 2018, and the experimental group from September 1-13, 2018. Self-efficacy and self-care adherence were assessed via questionnaires; user experiences were assessed via interviews after the application was used for 4 weeks.

RESULTS

After four weeks of use, transplant recipients reported significantly higher self-efficacy (F = 55.87, p < 0.001) and self-care adherence (F = 9.68, p = 0.003). Five themes were derived for the user experiences: (1) taking initiative for self-care, (2) utilizing a novel tool for self-care, (3) experiencing obstacles in ongoing self-care, (4) focusing on self-care adherence through the tool, and (5) expecting the application to serve as a personal medical assistant.

CONCLUSIONS

The health diary application is expected to motivate heart transplant recipients to perform self-care and improve adherence to medical advice.

The mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure

AIM

There have been few studies done looking at the relationship between resilience, Type D personality, and self-care behavior in patients with heart failure. The purpose of this study was to identify the mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure.

METHODS

The subjects consisted of a sample of 90 heart failure patients aged ≥20 years who visited the cardiology outpatient clinic in the Chungbuk area of South Korea.

RESULTS

Among 90 patients, 49 subjects (54.0%) were classified as Type D personality, who exhibited statistically significant differences in resilience and self-care behavior (p < .001). A statistically significant correlation was also observed between self-care behavior score and resilience score (p < .01). The resilience had full mediation effects on the relationship between Type D personality and self-care behavior. In other words, the higher their resilience, the better their self-care behavior.

CONCLUSIONS

The study showed that resilience and Type D personality have important effects on self-care behavior.